Action-Oriented Evaluation of an In-Home Family Therapy Program for Families at Risk for Foster Care Placement
McWey, Lenore M., Humphreys, Julie, Pazdera, Andrea L., Journal of Marital and Family Therapy
The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.
In-home therapy, a family preservation strategy, is growing in popularity and is a relatively new area of practice for marriage and family therapists (MFTs; Yorgason, McWey, & Felts, 2005). The goal of family preservation services is to prevent the removal of children from the home whenever safely possible (Pope, Williams, Sirles, & Lally, 2005). Most recent statistics suggest that the families of approximately 500,000 children participated in family preservation services following investigations of alleged abuse and neglect during 2000-2005 (Administration for Children and Families, 2008). Given the potential consequences of ineffective services, which include temporary family disruption and/or eventual termination of parental rights, there is an increased need for community agency accountability for those serving "at-risk" families (Quinn, 2007).
Despite the need for accountability and the grave consequences of ineffective services, there remains a gap between research and practice specifically related to in-home family therapy for at-risk families (Barth et al., 2007). Liddle et al. (2006) assert that to improve community-based services we need "real data about roadblocks and fresh insights about the specific difficulties involved in change" (p. 102). As an effort to capture perceptions of real-world practice, the purpose of this project was to conduct an action-oriented evaluation of an in-home family therapy agency aimed to improve the functioning of families who are at risk for the placement of their children in foster care.
Overview of In- Home Family Therapy
Decades ago, Bronfenbrenner (1986) asserted that child maltreatment is a manifestation of community conditions as much as it is a reflection of parents, and urged scholars to view maltreatment ecologically. An ecological framework involves considering families within multiple, interactive contextual layers ranging from individual factors to community issues and broader social contexts. Today, many agree that an ecological perspective is needed to advance the treatment and prevention of child maltreatment (e.g., Cicchetti & Lynch, 1993), and this theoretical perspective is often the premise of home-based family preservation services (Pope et al, 2005).
Minuchin (1974) began integrating family therapy and in-home services for at-risk families in the 1970s. In 1980, the Child Welfare Act was passed, which required "reasonable efforts" be made to prevent the removal of children from the home (Bagdasaryan, 2004, p. 616). The passage of that act, coupled with preliminary studies demonstrating positive outcomes associated with Homebuilders, a specific family preservation model, led to a dramatic increase in home-based preservation services (Little, 1997). Today, Multisystemic Therapy (MST; Henggeler et al, 1999) and Multidimensional Family Therapy (MDFT; Liddle, 2002) - both home-based, family treatment models - have been recognized by the National Institute of Health (NIH) as effective treatment approaches specifically for drug abuse (NIH, 2008). Both models developed from an ecological framework where treatment involves individuals, families, and aspects of the broader community including schools and the juvenile justice system. …